Covid-19 in the Emergency Department: development of an echo-integrated clinical score guiding hospital admission and prognostic assessment

Background: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease. Information about prognosis may importantly affect physicians’ decisions in the emergency departments (ED). The primary aim of the study is to identify and analyse the parameters that are significant for the prognosis prediction and based on them and the data present in literature, to develop a multivariable risk score that could aid the Emergency Department doctor in the decisions-making and management of patients presenting with COVID-19. Secondarily, another aim is to compare the resulted score with the currently most used prognostic score for community acquired pneumonia (CURB-65). Methods: A cohort of 312 laboratory-confirmed COVID-19 patients underwent to the needed clinical evaluation, blood tests and lung ultrasound (LUS) in the ER. LUS score was derived from 12 ultrasound lung windows. Endpoints assessed were the critical care need [need of CPAP,/NIV of orotracheal intubation, hospital admission in an Intensive Care Unit (ICU)], and death. Findings: A simple risk score (CSI-56) was developed to predict outcomes. Sensitivity, specificity and corresponding risk of critical care need of CSI-56 were respectively 75.4% and 86.5%. CSI-56 was a significantly stronger predictor of overall mortality than CURB-65 (AUROC = 0.863 vs. 0.610, p <0.001) Conclusions: As a result of this study, an easy and effective scoring system (CSI-56) has been developed and proposed as to guide clinical decisions in patients with Covid-19. Being used alongside clinical judgement, the score may improve the care efficiency and enhance safety by improving the appropriate clinical management and prognostic stratification in the challenging setting of the Emergency Department during the pandemic of Covid-19.